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Countdown to Obamacare Rollout

Thirty-one days from now, the state insurance exchanges mandated under Obamacare will open for business.

At least, that's the plan. Roadblocks in the form of incomplete websites, less than adequate security, and bugs in the system may significantly delay the opening of some aspects of the insurance exchanges.

But ready or not, here we come; Obamacare implementation is set to begin in earnest.

The Hill:

The success or failure of the healthcare law doesn’t hinge entirely on Oct. 1, which falls on a Tuesday when Congress will be in session. But it’s nevertheless a critical date in the implementation effort, and will mark the public's first real look at the centerpiece of a law that has dominated domestic politics for years.

The White House has two big tasks over the next month: Make sure the new marketplaces are ready for prime time; and get people interested in signing up for coverage.

The public-relations push will get a big jolt this week from former President Clinton, who is scheduled to give a speech Wednesday making the case for the new law.

Clinton’s reputation as “explainer in chief” could be a big asset as the Obama administration tackles a daunting education effort: A recent Kaiser Family Foundation poll found that 44 percent of those surveyed didn’t know whether the Affordable Care Act is still on the books.

The administration's enrollment efforts come as some conservatives in Congress are pushing for ObamaCare to be defunded.

The law is poorly understood as well as unpopular, and its supporters believe public opinion will turn around if and when people get a better handle on what the law does (and, just as importantly, what it doesn’t do).

In the short term, the goal is less to win a political argument against Republicans than to make sure the uninsured are at least willing to explore their options — and know where to go.

“The test of this is going to be is it working. And if it works, it will be pretty darn popular,” President Obama said in a July interview with The New York Times.

So far, the enrollment pitch is focused far more on health insurance than on the ObamaCare brand.

The states that are building their own insurance marketplaces haven’t emphasized in their own enrollment drives that the marketplaces are part of ObamaCare.

California launched its first television ads last week, adopting the same strongly local flavor as other states that are invested in the law’s success. Ads in California, Oregon, New York and elsewhere play to their states’ unique attributes and frame insurance as a basic safety net.

It is doubtful that people will be rushing to the exchanges in order to pick their insurance policies, although if someone wants a subsidy to help pay for their plan, they must go through the exchanges to get it. There are also questions about how much of an increase people will see in their premiums, and whether they will be able to keep the policy they have if they like it.

The exchanges have already been streamlined, eliminating some requirements of Obamacare in order to get them up and running. But will they work? Or will they crash in a hopeless mess when consumers access them?

Marketplaces in California and Oregon said this month that technical hurdles may force consumers to apply with a broker or counselor instead of online when the exchanges start Oct. 1. In Colorado, managers are literally working around the clock to ensure computer systems share accurate Medicaid data.

On the East Coast, exchange managers voiced concern that millions of Americans without health insurance don’t know about the new shopping hubs. Kevin Counihan, chief executive of Access Health CT, Connecticut’s exchange, even attended a concert featuring rapper Lil Wayne to get the word out to young people, then reported his progress to President Barack Obama and state officials last week in a videoconference.

“We got 500 names of people who want information,” Counihan said. “The president asked me if I had any pictures of the Lil Wayne concert. I said that I do, but my daughter has asked that they not see the light of day.”

The possibility of crashes are pretty high:

The reality is all of the technology timelines are very tight,” said Gretchen Hammer, board chairwoman for the Colorado exchange. “There are a number of the key technology aspects that remain in testing.”

Integrating new computer systems and existing Medicaid databases is a primary challenge for exchanges from a technology perspective, said Dan Schuyler, a director for Leavitt Partners, a consulting firm that is advising states on their marketplaces.

“Medicaid systems across the country use a variety of different data systems,” he added. “Some are old and outdated and many are involved in modernization projects.”

If computer systems fail to interact, it could lead to inaccurate eligibility determinations for Medicaid, said Colorado’s Reiter.

Even as they sought to reassure board members on Aug. 26 that Colorado’s exchange will open on time to serve 1 in 6 residents, or about 829,000 people, who are without health insurance, managers cautioned the new venture will likely endure growing pains.

“Our biggest concern is the amount of time we have to complete around testing and around training,” said Patty Fontneau, executive director of Colorado’s exchange. “We are going to open Oct. 1. Will there be bumps in the road? Yes. We are literally going to have people working around the clock to meet these deadlines.”

Obamacare supporters are afraid that problems with accessing the site, or breakdowns, or other SNAFUs might discourage people from seeing the process through to completion. That's a distinct possibility -- especially in those states where the feds are constructing the exchanges. They tend to be farther behind and will likely see more problems than states building their own hubs.

This is Obama's biggest roll of the dice. The chances of them coming up snake's eyes are better than rolling a seven.